Antimicrobial resistance is an urgent, global crisis

Responses to a nationwide survey indicated that while most Americans are aware of the dangers posed by infections that have grown increasingly resistant to current antibiotic treatments, only about half know enough about the correct use of antibiotics to prevent resistance from occurring. 

{mosads}As a physician, I have had to hope that patients’ immune systems could fill the gap left by failing treatments against antibiotic-resistant infections. As the president of the Infectious Diseases Society of America, which, with Research!America, commissioned the survey, the responses both encourage and alarm me.

Americans are right to be concerned that the antibiotic treatments that ushered in the era of modern medicine are losing their power to stop infections. These life-saving medications are essential, for example, to allow patients to get through cancer treatments and transplants that were not possible before. It is clear, however, that more public education is needed about how, when and why antibiotics work. We also need a ready pipeline of new infection-fighting drugs, to protect patients and the public from increasingly resistant pathogens.

For too long these have been treated as abstract goals. For the two million people in the United States who become ill with infections that are resistant to treatment, these needs are real and immediate. I have vivid memories of a woman in her 20s, in the surgical intensive care unit after an abdominal procedure, with an infection that was completely resistant to every antibiotic that had been tried. I remember searching on my computer and calling colleagues, hoping for answers and I remember the sinking feeling that I was looking at a young woman who shouldn’t be dying but was. At least 23,000 people die from antibiotic-resistant infections every year in the United States and many more die because of complications from those infections.

I am encouraged that the people who were surveyed, across the political spectrum, recognized the threat and also feel that the federal government should be doing more than it is to address this critical issue. I am alarmed because the response needed is not happening fast enough.

The survey answers demonstrate substantial gaps in public knowledge. Thus, the survey answers should be taken as a call-to-action to strengthen public health efforts countering antibiotic resistance. While 90 percent of those asked agreed that antibiotics should only be taken when prescribed by a health-care professional and even more agreed that health-care professionals should only prescribe antibiotics when needed, more than a third of those surveyed incorrectly believe that antibiotics can effectively treat viruses and almost as many expect their physician to prescribe antibiotics for that purpose.

All the while, continuing high levels of inappropriate antibiotic use in both inpatient and outpatient settings, underscore the need for greater federal action to ensure antibiotic stewardship programs are present in all of our hospitals under infectious diseases clinician leadership. 

But, as survey respondents agreed, filling those knowledge gaps is only one small step in reversing rising trends of antimicrobial resistance. I’m encouraged that more than three-quarters of respondents agreed the federal government should increase funding for research as well as public health initiatives to address antibiotic resistance, while nearly three-quarters agreed that the federal government should provide incentives to encourage increased private sector investment in the development of new antibiotics.

The slow financial return on medicines taken exclusively in limited courses has discouraged needed investments in antibiotic research. Strategies to drive and reward the development of new drugs will be critical components to building the arsenal to reverse current antimicrobial resistance trends.

I am glad that agreement on the role that the federal government should play in confronting antimicrobial resistance spanned political divisions. But I am concerned that Americans still may not understand the scope of the threat that faces us.

We have watched antimicrobial resistance grow and new more resistant bacteria appear. Nearly in parallel, we have witnessed increasingly effective cancer therapies emerge. Without action and innovation, we risk being able to increasingly cure the patient’s cancer only to lose them to resistant infections. Importantly, antibiotic resistance is now estimated to contribute an additional $20 billion to health-care costs every year in the US alone.

It is crucial to recognize that antimicrobial resistance is not our problem alone, but a global problem with disastrous ramifications. If we do not begin to address antimicrobial resistance around the world — including by strengthening stewardship with telemedicine — we will not win.

Americans recognize and have voiced the need to confront antimicrobial resistance across the board. It is now time for government, industry and innovators to show they have been heard. A multi-prong and global approach — with strong stewardship to protect the antibiotics we have and the ones to come, incentives to ensure that development of new antibiotics meets our patients’ needs and investment in research and public health initiatives — is necessary to turn the tide against antibiotic resistance. 

Cynthia Sears, M.D. is president of the Infectious Diseases Society of America, a professor of medicine at the Johns Hopkins University School of Medicine and a member of the Johns Hopkins Kimmel Cancer Center as well as a member of The Bloomberg-Kimmel Institute for Cancer Immunotherapy.